Conventional retractors, used in surgical procedures of the abdomen, thorax, vagina, etc., often utilize rigid or semi-malleable metallic retractors applied to influence the position of tissues within and adjacent to the operative field. These conventional retractors are available in a plurality of sizes, shapes, and configurations, but a common feature is rigidity of the basic materials of construction. A problem with rigid retractors is that their unyielding nature can have untoward effects, such as neuronal impingement, pressure necrosis of soft tissue, incomplete hemostasis requiring additional efforts to achieve hemostasis (e.g., electric cautery), asymmetric retraction of soft tissue. Some of these can have secondary effects. For example, neuronal impingement from conventional retractors can result in transient or residual deficits. Another shortcoming of conventional retractors is the need for a surgical assistant to physically hold the retractor by hand and thereby apply the tissue retracting force.
Attempts to overcome these problems include increasing the retractor-tissue interface areas and introducing a curvature to the retractor blade. However, in practicality, the lateral edges of the rigid retractor blade still present a localized focus of high pressure against soft tissue. Also, specific locations of the underlying sensitive structures, such as nerve fibers and blood vessels and lymphatic channels, are subject to extensive anatomic variation. The surgeon must therefore exercise the judgment and wisdom of experience to arrive at a “best-guess” location for application of the retractor blade to preferably avoid compression of these structures.
The above-identified attempts to solve or reduce problems such as neuronal impingement, pressure necrosis of soft tissue, incomplete hemostasis, and asymmetric retraction of soft tissue, in addition to being unsatisfactory for certain applications, do not remove the requirement for a surgical assistant to hold the retractor. The requirement for a surgical assistant can introduce additional problems. For example, the assistant may become fatigued. In addition, the assistant has a different perspective than the primary operation, i.e., the surgeon, and may therefore inaccurately place the retractor. Also, the assistant may have suboptimum exposure within the operative field.
Attempts to eliminate the need for a surgical assistant include rigid or malleable metallic retractor blades attached to self-retaining retraction frames. The blades can be connected to surgical table accessories or to flexible/lockable retraction arms. However, although such retractors can be partially or totally within the sterile operative field, they extend well beyond the general dimension of the incision site. This can cause a reduction in the surgeon's access to the operative site due to interference by the external frameworks. Also, the frameworks can potentially obstruct the surgeon's vision, for example, when intra-operative complications necessitate a change in surgical approach. IN addition, the ultimate tissue retraction is still achieved by means of rigid or malleable metallic retractor blades, thereby inducing the previously mentioned problems with hemostasis, necrosis, neuronal impingement, etc.
Therefore, a need exists for a tissue retractor that eliminates, or at least significantly reduces retractor-related problems such as, but not limited to, the examples described above.